Anaphylactic Shock Following Intravenous Ranitidine: A Near-Fatal Case from Rural Nepal and Lessons for Low-Resource Settings

Background Ranitidine, a histamine-2 (H2) receptor antagonist, is widely used for acid-peptic disorders. Although generally safe, it is a rare but recognized cause of drug-induced anaphylaxis, with an estimated incidence of 0.2–0.7% for H2 receptor blockers and proton pump inhibitors. We report a near-fatal case of ranitidine-induced anaphylactic shock successfully managed in a rural hospital. Case presentation A 35-year-old female developed sudden shortness of breath, hypotension, and drowsiness within minutes of receiving a 50 mg intravenous dose of ranitidine for epigastric discomfort at a local clinic. She had no prior exposure to ranitidine or known allergies. On arrival, her blood pressure was 60 mmHg systolic, pulse 130/min, and SpO₂ 60%. She had diffuse urticaria and wheezing. A diagnosis of anaphylactic shock was made. Immediate management included high-flow oxygen, intramuscular epinephrine (0.5 mg, 1:1000), followed by intravenous hydrocortisone. Significant improvement occurred within 10 minutes and she was discharged after 24 hours of observation. Conclusion This case underscores the need for awareness that even common drugs like ranitidine can trigger anaphylaxis. In low-resource settings, early recognition, prompt epinephrine use and the availability of life-saving medications are crucial to prevent fatal outcomes.